Comptroller: NYSDOH Leaves $95 Million of Drug Rebates on the Table

This week, the New York State Comptroller, Thomas P. DiNapoli, issued audit findings which claimed that the New York State Department of Health (“DOH”) failed to capture $95,100,000 in prescription drug rebates it was eligible to receive on drugs administered through the New York State fee-for-service program and the Medicaid Managed Care program from April […]

Behavioral Home and Community-Based Services Delayed

The New York State has delayed implementation of Behavioral Home and Community-Based Services (“HCBS”) outside of New York City.  These new services were scheduled to begin on July 1, 2016, but are now slated to be phased in three months later, on October 1, 2016. Non-HCBS behavioral health care services will be offered through Medicaid […]

New OIG Fraud Alert Focuses on Compensation of Medical Directors

The United States Department of Health and Human Services Office of Inspector General (“OIG”) issued a short Fraud Alert last week focusing on the anti-kickback implications of certain compensation paid to medical directors. OIG noted that it had recently settled with a dozen physicians who had entered into medical director positions of various health care […]

Office of the State Comptroller Issues Medicaid Program Integrity Report

The New York State Medicaid program is projected to have a $62 billion-dollar price tag in State Fiscal Year 2016, with $22.4 billion paid out by the State, as explained by the New York State Office of the Comptroller (“OSC”) in its April 2015 report entitled Ensuring Integrity in New York State Medicaid.   As Medicaid […]

Office of The Medicaid Inspector General Releases 2015-2016 Work Plan

The New York State Office of the Medicaid Inspector General (“OMIG”) has released its State Fiscal Year 2015-2016 Work Plan.  The Work Plan is a road map of where the OMIG intends to go in terms of its anti fraud, waste and abuse efforts with respect to the Medicaid program. The OMIG’s stated mission is […]

Regulatory Focus on Mental Health Parity Laws

This month’s article from the Albany County Bar Association Newsletter discusses the New York Attorney General’s recent settlement with Excellus, a Rochester-based health insurer, which resulted from an investigation into complaints from consumers that Excellus was improperly denying claims for mental health and substance abuse treatment.  The article also includes a brief overview of New […]

Attention DSRIP Performing Provider System Leads: OMIG Highlights Special Considerations for Compliance Plans

The New York State Office of the Medicaid Inspector General (“OMIG”) has released Compliance Guidance for use by DSRIP (Delivery System Reform Incentive Payment)  Performing Provider System (“PPS”) Leads who are in the process of developing and implementing a compliance program.  The document highlights special considerations PPS Leads should contemplate for each of the eight […]

HHS Looks to Collect $12 Million from New York State for Unallowable Continuous 24-Hour Personal Care Services

In 2011, the United States Department of Health and Human Services Office of the Inspector General (“HHS OIG”) investigated New York City’s Medicaid claims for continuous 24-hour personal care services, an area that previous HHS OIG audits consistently identified as one vulnerable to  fraud, waste, and abuse.

New York State’s Medicaid Fraud Control Unit by the Numbers

Medicaid Fraud Control Units (“MFCUs”) have a responsibility to combat Medicaid fraud and patient abuse and neglect.  Toward that end, each MFCU maintains statistical data as to the number of investigations, indictments, and convictions by the MFCUs, as well as the amount of monetary recoveries for both civil and criminal cases.  Each year, a summary […]